Gomez-Paz Santiago, King Patrick, Gomez Alwyn, Grandhi Ramesh
Department of Neurosurgery, Clinical Neuroscience Center, University of Utah, Salt Lake City, UT, USA.
Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Interv Neuroradiol. 2024 Dec 20:15910199241305691. doi: 10.1177/15910199241305691.
The integration of robotics into neuroendovascular surgery has the potential to revolutionize the field by enhancing precision, reducing procedure-related risks, and improving patient outcomes. The CorPath GRX system represents a significant advancement in this domain. In this systematically conducted scoping review, we explore the current applications, advances, and challenges associated with robot-assisted neuroendovascular surgery.
A comprehensive literature search was conducted across PubMed, Scopus, Embase, and Web of Science, covering publications from January 2015 to December 2024. Relevant data were extracted from studies involving human subjects and reporting the use of robotic guidance with the CorPath GRX system for neuroendovascular procedures for review and discussion.
We identified 14 studies with a total of 336 patients who underwent robot-assisted neuroendovascular procedures, including both diagnostic (48.2%) and therapeutic (51.8%) applications. Among the therapeutic interventions, 140 patients were treated for hemorrhagic pathology, including 128 procedures for unruptured intracranial aneurysms and 12 for ruptured aneurysms. These procedures primarily involved stent-assisted coiling or flow diversion therapy. Additionally, 34 patients were treated for ischemic pathology, primarily carotid artery stenosis, involving balloon angioplasty and stent placement. A tumor was addressed in 1 intervention via coil embolization of tumor feeders, showcasing the versatility of robot-assisted interventions. Technical success rates were high across the studies, with most procedures achieving 100% success. Manual conversions were for device malfunctions or anatomical challenges. Complications reports varied, with some studies detailing specific device malfunctions and others providing less specific accounts.
Overall, the CorPath GRX system demonstrated high feasibility and safety for neuroendovascular procedures, indicating significant potential benefits, particularly if integrated into telemedicine practices. The CorPath GRX system shows promise in facilitating precise and safe neuroendovascular procedures. Current evidence highlights a wide range of benefits; however, further research is needed to investigate long-term outcomes and other potential areas of impact.
将机器人技术整合到神经血管内手术中，有可能通过提高精度、降低手术相关风险和改善患者预后，给该领域带来变革。CorPath GRX系统代表了这一领域的重大进展。在这项系统开展的范围综述中，我们探讨了与机器人辅助神经血管内手术相关的当前应用、进展和挑战。
在PubMed、Scopus、Embase和Web of Science数据库中进行了全面的文献检索，涵盖2015年1月至2024年12月的出版物。从涉及人类受试者且报告使用CorPath GRX系统进行机器人辅助神经血管内手术的研究中提取相关数据，进行综述和讨论。
我们确定了14项研究，共有336例患者接受了机器人辅助神经血管内手术，包括诊断性（48.2%）和治疗性（51.8%）应用。在治疗性干预中，140例患者因出血性病变接受治疗，包括128例未破裂颅内动脉瘤手术和12例破裂动脉瘤手术。这些手术主要涉及支架辅助弹簧圈栓塞或血流导向治疗。此外，34例患者因缺血性病变接受治疗，主要是颈动脉狭窄，涉及球囊血管成形术和支架置入。1例干预通过对肿瘤供血动脉进行弹簧圈栓塞治疗肿瘤，展示了机器人辅助干预的多功能性。各项研究的技术成功率都很高，大多数手术成功率达到100%。手动转换是由于设备故障或解剖结构复杂。并发症报告各不相同，一些研究详细描述了特定的设备故障，另一些研究则提供了不太具体的描述。
总体而言，CorPath GRX系统在神经血管内手术中显示出高度的可行性和安全性，表明其具有显著的潜在益处，特别是如果整合到远程医疗实践中。CorPath GRX系统在促进精确和安全的神经血管内手术方面显示出前景。目前的证据突出了广泛的益处；然而，需要进一步研究来调查长期结果和其他潜在的影响领域。
